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Dermatologic Manifestations of Enteroviral Infections Workup

  • Author: Mercè Alsina-Gibert, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jul 12, 2016
 

Laboratory Studies

Enteroviral infections are diagnosed mainly on the basis of clinical features; however, a specific diagnosis of enterovirus infection requires detection of the virus in patient samples. In some cases, complementary tests may be useful.

Serologic studies

The detection of virus-specific immunoglobulin M (IgM) antibodies by means of enzyme-linked immunosorbent assay can aid diagnosis and can be detected as early as 2 days of infection.

Serum samples should be obtained during the acute phase of the disease because IgM antibodies rapidly disappear. The antibodies are usually group specific and not type specific.

No universal antibody or antigen assay exists because no single antigen is present in all enterovirus serotypes. Serology has no role in routine diagnosis.

Cell culture

Cell culture may allow isolation of the virus. Samples may be obtained from the blood, stool, pharyngeal secretions, or vesicular fluid. Some reports suggest that the best results are achieved when samples are collected from the upper respiratory tract, gastrointestinal tract, or cerebrospinal fluid.

The most specific findings are found in samples from blood and blister fluid. Findings in fecal specimens are least specific because enteroviruses may be shed for weeks after acute infection and can be detected well after the clinical illness has resolved. A 2007 study revealed that a throat culture plus a culture of 2 sterile vesicles (or from the rectum if no sterile vesicles are present) may have the highest yield for detecting enterovirus 71 in persons with hand-foot-and-mouth disease (HFMD).[31]

Although enteroviruses take 4-8 days to grow and results are usually not available in sufficient time to impact treatment of the patient, culture remains an important epidemiologic tool. Viral culture allows the clinician to isolate and identify the serotype of the virus causing disease.

Polymerase chain reaction

The reverse-transcriptase polymerase chain reaction (PCR) has made enteroviral subtyping possible and has increase the enterovirus detection rate, especially in the analysis of cerebrospinal fluid.

As a reaction to the August, 2014 enterovirus D68 (EV-D68) outbreak in the United States, the US Centers for Disease Control and Prevention has developed and begun using a new and faster laboratory test for EV-D68.[32] With this new reverse-transcription PCR testing, the CDC can test new specimens and obtain results within a few days, rather than the few weeks it took previously.

Real-time reverse-transcriptase PCR assays permit shorter turnover times, especially for the detection of enterovirus RNA.[33]

PCR techniques require small amounts of clinical material and are rapid (within 5-24 h of receipt of the sample), sensitive, and specific. PCR is superior to viral culture for the diagnosis of many enterovirus infections, particularly enteroviral meningitis.[34] Specimen sources are the same as those for cell cultures, as outlined above.

Commercial enterovirus PCR tests are available.

Because of their extreme sensitivity, PCR tests are subject to false-positive results due to contamination and to false-negative results due to levels below assay detection.

Enterovirus PCR provides the potential for a reduction in unnecessary hospitalization and diagnostic or therapeutic interventions.

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Histologic Findings

In most cases, histopathologic findings are nonspecific and are not necessary for diagnosis.

When histopathologic examination is performed to evaluate HFMD, findings may include spongiosis, intraepidermal vesicles that contain neutrophils and mononuclear cells, and some necrotic keratinocytes.[35, 36, 37] Edema and a perivascular infiltrate composed of lymphocytes and neutrophils may be seen in the dermis.

In eruptive pseudoangiomatosis (EP), lesions are composed of dilated superficial vessels with plump endothelial cells. The lesions are easily distinguished from true angiomas because the number of vessels is not increased.

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Contributor Information and Disclosures
Author

Mercè Alsina-Gibert, MD Consultant, Department of Dermatology, Hospital Clinic, Spain

Disclosure: Nothing to disclose.

Coauthor(s)

Steven Brett Sloan, MD Associate Professor, Department of Dermatology, University of Connecticut School of Medicine; Residency Site Director, Connecticut Veterans Affairs Healthcare System; Assistant Clinical Professor, Yale University School of Medicine

Steven Brett Sloan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Connecticut State Medical Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Journal of the American Academy of Dermatology;Up to Date;Medical Review Institute of America.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Chad S Hendrickson, MD Resident Physician, Department of Dermatology, San Antonio Uniformed Services Health Education Consortium

Disclosure: Nothing to disclose.

Alex Llambrich-Mañes, MD Resident Physician, Department of Dermatology, University of Barcelona, Spain

Disclosure: Nothing to disclose.

Susanna Nogués-Siuraneta, MD Resident Physician, Department of Dermatology, Hospital Clinic de Barcelona

Disclosure: Nothing to disclose.

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Erosions on the base of the tongue.
A red halo surrounds several vesicles on the finger flexures and palms.
Small linear vesicle on the thumb.
Vesicle on the dorsal hand of a young adult.
 
 
 
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